In the younger population, eye bags are often solely the results of these outpouchings, with or without tear troughs. Whereas in the older population, these orbital fat outpouchings are often associated with lax skin, muscle, and tear troughs, and malar festoons.
Some eye bags, however, are not real. These “fake” eye bags exist, and thus a careful diagnosis of eye bag is critical to the proper selection of treatment options.
One common condition of “fake” eye bags is hypertrophic or enlarged pretarsal muscle under the eyelash in the lower eyelids, often becoming exaggerated when smiling.
Another “fake” eye bags is tear trough deformity. Tear trough is a sunken trough area of volume loss below the lower eyelids. Tear trough is often associated with eye bags.
Another “fake” eye bags are malar festoons, which are localized squishy swelling on the cheek bone below the orbits.